Provider Demographics
NPI:1235382425
Name:EDOUARD, RENEE CUPIDON
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CUPIDON
Last Name:EDOUARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 PARK DR E
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1951
Mailing Address - Country:US
Mailing Address - Phone:718-268-4082
Mailing Address - Fax:
Practice Address - Street 1:7017 PARK DR E
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-1951
Practice Address - Country:US
Practice Address - Phone:718-268-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204547164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY204547OtherNY NURSING LICENSE NUMBER